How much Inflectra infusions cost (with and without insurance) and how patients can lower the cost of their infusions.
The U.S. Food and Drug Administration (FDA) approved Pfizer-manufactured Inflectra (the brand name for infliximab-dyyb) in 2016. It’s the first biosimilar to Janssen Biotech-manufactured Remicade (infliximab), which was initially licensed in 1998.
Inflectra is used to treat:
- Crohn’s disease
- Ulcerative colitis
- Rheumatoid arthritis (in combination with methotrexate)
- Ankylosing spondylitis
- Psoriatic arthritis
- Plaque psoriasis
This biologic drug is a TNF-blocker which, as the name suggests, means it works by blocking a protein called tumor necrosis factor.
As with any FDA-approved intravenous treatment, Inflectra can be expensive for a few reasons. First and foremost, it’s a biologic medication that’s expensive to produce. But most eligible patients also need regular maintenance infusions over long periods of time, which can contribute to higher costs.
Below, we break down how much Inflectra infusions cost (with and without insurance), along with how patients can lower the cost if they decide to proceed with this treatment option.
How much does Inflectra cost?
Inflectra is available as a 100 mg/vial solution for intravenous infusion at a price of $525 per vial. The total dose a patient will be prescribed depends on their condition as well as a few other factors that can be discussed with their doctor.
How does insurance coverage impact the cost of Inflectra?
How much the patient pays (aka out-of-pocket costs) is ultimately a function of the insurance plan. Every plan is different, but there are a few concepts that are important to remember:
- Copay: a fixed amount of money that you pay for a healthcare service, which generally totals $0-$50 per visit
- Coinsurance: a percentage of the total cost of a healthcare service
- Deductible: an amount of money you must pay before your health insurance plan starts to share costs
- Or a combination of these options
Don’t have insurance or aren’t in-network with your infusion center? It may be possible to bill your insurance company for the medication costs out-of-network. If out-of-network benefits aren’t available, you may be able to be seen as a self-pay patient.
How does site of care impact the cost of Inflectra?
The only decision a patient can make to influence the cost of their infusion is to decide where to receive treatment. Generally, there are three options where a patient may receive prescription drug infusion therapy from a healthcare professional:
- Hospital outpatient
- Home
- Office setting (Ambulatory Infusion Center or Specialty Doctor’s Office)
Hospital outpatient is where 50-60% of infusions take place nationally. The cost is generally ~2x what it costs in the home or office. Home infusion has received a lot of press recently, but according to the National Infusion Center Association, it tends to be 50% more expensive than a healthcare provider’s office. The office setting will be the most affordable care setting for patients who have received a referral from their physician for infusion therapy.
How can I lower the cost of Inflectra infusions?
Pfizer has an enCompass Co-Pay Patient Assistance Program which provides eligible, commercially-insured patients up to $20,000 per calendar year. Note, however, that this plan is not valid for patients enrolled in a state or federally funded insurance program (e.g., Medicare, Medicaid, TRICARE, Veterans Affairs, state prescription drug assistance program, etc).
How Local Infusion can help
At Local Infusion, each patient is paired 1:1 with a Guide who works with you to determine your out-of-pocket costs and what financial programs you’re eligible for. Guides also handle everything related to prior authorization.
For questions regarding pricing and insurance, our team will work together to provide guidance on financial assistance support and help our patients minimize costs where possible.
READ MORE: Why Local Infusion
